Integrative Medicine: NATO’s Task Force Report

North Atlantic Treaty Organization’s Task Force Human Factors and Medicine (HFM)-195 has just published the results of their deliberations on integrative medicine interventions for military personal. The findings were published as NATO Special Edition-Integrative Medicine Interventions for Military Personnel in the October 2015 issue of Medical Acupuncture, 27(5). The individual articles range from historical perspectives to analysis of clinical applications of CAM. The individual articles can be downloaded – free of charge – from

The articles point out that the current health care system must adapt and include the utilization of complementary and alternative medicine (CAM). It is not main stream medicine versus CAM. It is how to integrate the best of both approaches and offer the most effective integrative medicine. The objectives of the report are:

  • To improve health care systems and increase available treatment options for patients.
  • To identify and to evaluate the various countries’ data on the utilization (rationale, frequency, accessibility) of CAM among Military personnel.
  • To learn about the acceptability of CAM by the leadership of Military organizations, and review briefly the current regulatory and legal status of CAM utilization and its implementation.
  • To explore NATO-wide implementation of selected CAM modalities (e.g., acupuncture, meditation/mindfulness programs, movement/yoga, biofeedback), with ongoing analysis of efficacy, cost-effectiveness, suitability, and acceptability.
  • To develop acceptable terminology, regulatory policies, and educational literature.
  • To expand perspectives and understanding of cross cultural initiatives and research project.

Look at the articles in the journal. It is a great resource.

Cover for Medical Acupuncture

Letting go of stress and worry*

Presentation1One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, “My son, the battle is between two wolves inside us all.”
“One is Evil –  It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.”
“The other is Good –  It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith.”

The grandson thought about it for a minute and then asked his grandfather: “Which wolf wins?”

The old Cherokee simply replied, “The one you feed.”

–Author and source unknown

 Are you stressed and worrying what will happen? Are you thinking of all that could go wrong? Do you feel overwhelmed and anxious?

It is very challenging to let go of negative thoughts, images, memories and anticipations. These negative worries can be useful if they mobilize you towards active planning and action; however, in most cases, the thoughts continue to go around and around in our heads. The more we worry, the worse we feel. Often our shoulders and neck tighten and our stomach churns. The worries and concerns may become a pain in the neck and we no longer can stomach the stress.

Begin to take charge and realize that even though health and healing is not our control, we can contribute and support the healing process. Regardless how overwhelmed we are, begin with the basics. Start the day by respecting your body so that it can run well. It needs:

Proper fuel. Begin by having breakfast—not the sugar coated cereals or snack bars on the run—but an egg, oatmeal, and some fruit or other non-processed foods. Even when you think you do not have the time, fuel up your body so your body engine can work well. Drink only one cup of coffee with little sugar. Drink water or tea and avoid all soft drinks and any low calorie drinks. Remember that people who drink low calorie soft drinks increase their abdominal girth by three inches as compared to people who do not drink low calorie soft drinks (Fowler et al, 2015).

Follow-up with lunch and dinner, do not skip meals! Many of my college students do not eat breakfast or lunch before coming to class, as a group they are more reactive, anxious and perform significantly poorer on exams than the ones who do eat.

If you haven’t eaten, or eaten only high sugary snack foods an hour or two before, your blood sugar will lower and you become more reactive “Hangry” (the combination of hungry and angry). As the blood sugar drops, the brain reactivity pattern changes and you become much more impulsive (Peper et al, 2009).

Dynamic movement. The moment you do some movement your urge to snack, smoke, or  ruminate is significantly reduced. When you begin physical movement (especially when you do not want to), the built up tension from the personal and interpersonal stress will decrease. You are completing the biological alarm reaction. When you physically move, you dissipate the fight/flight response and are shifting your body to a state of regeneration. As the alarm reaction response decreases, it becomes easier to do problem solving and abstract thinking. As long as you are in the alarm state, you tend to react defensively to the immediate events. Thus, when you feel uptight and stressed, take a hike. Walk up the stairs instead of taking the escalator, get off Muni one stop earlier and walk rapidly to your destination.

Positive and peaceful thoughts. Remember your thoughts, memories and images affect your body and vice versa. Experience how your thoughts effect your body. Have someone read the following to you. It takes only a few minutes.

Sit comfortably, and gently close your eyes and imagine a lemon. Notice the deep yellow color, and the two stubby ends. Imagine placing the lemon on a cutting board and cutting it in half with your favorite kitchen knife. Notice the pressure of the knife in your hand as you cut the lemon. Feel the drop of lemon juice against your skin. After cutting the lemon in half, put the knife down and pick up one half of the lemon.


As you look at it, notice the drops of juice glistening in the light, the half-cut seeds, the outer yellow rind, and the pale inner rind. Now get a glass and squeeze this half of lemon so the juice goes into the glass. As you squeeze, notice the pressure in your fingers and forearm. Feel droplets of lemon juice squirting against your skin. Smell the pungent, sharp fragrance. Now take the other half of lemon and squeeze the juice into the glass. Now take the glass in your hand. Feel the coolness of the glass and bring it to your lips. Feel the juice against your lips, and then sip the lemon juice. Taste the tart juice and swallow the lemon juice. Observe the pulp and seeds as you swallow (Adapted from Gorter and Peper, 2011).

What did you notice? As you imagined the lemon, did you notice that you experienced an increase in salivation, or that your mouth puckered? Almost everyone who does this exercise experiences some of these physical changes. The increase in salivation demonstrates that these thoughts and images have a direct effect on our bodies. Similarly, when we have thoughts of anger, resentment, frustration, or anxiety, they also affect our bodies. Unknowingly we may tighten our shoulders or our abdomen. We may unconsciously hold our breath or breathe shallowly. This response interferes with our ability to relax and heal. If this kind of tension is a constant habit, it reduces the body’s ability to regenerate.

Although we may dismiss our experience when we did the imagery exercise with an imaginary lemon—it was only an imaginary lemon, after all—it is fundamentally important. Every minute, every hour, every day, our bodies are subtly affected by thoughts, emotions, and images. Just as the image of the lemon caused us to salivate, our thoughts and emotions also cause physiological change.

What to do when consumed by worry. Although it seems impossible, you have a choice to focus on the negative  or positive thoughts. When you feel stressed and overwhelmed, ask yourself, do I have control over this situation?

If “No”, acknowledge that you feel frustrated and stuck. Recognize you want to let it go and have no control. Ask yourself “does this thought serve any purpose or help me in any way” If not, let go of the thought and the sensations in your body”   If there is a purpose or value act upon the thought (go feed the parking meter, make that call). Then do the following thought interrupting practice.

Sit up and make yourself tall on your sitz bones with your lower spine slightly arched at the same time look up and take a breath in. While inhaling, think of someone who loves you such as your grandmother an aunt. For that moment feel their love. Exhale softly while slightly smiling while still looking upward. As you exhale think of someone for whom you care for and wish them well.

Each time your brain begins to rehash that specific event, do not argue with it, do not continue with it, instead, initiate the thought interrupting practice. Many people report when they do this many, many, times a day, their energy, mood and productivity significantly increases. Initially it seems impossible, yet, the more you practice, the more the benefits occur.

If “yes,” make a list of all the things over which you have control and that need to be done. Acknowledge that this list appears overwhelming and you do not even know where to start. Begin by doing one small project. Remember, you do not have to finish it today. It is a start. And, if possible, share your list and challenge with friends or family members and ask them for support. The most important part is to move into action. Then, each time your brain worries, “I do not have enough time”, or “there is too much to do,” practice the thought interrupting practice.

               Watch your thoughts; they become words. 

               Watch your words; they become actions. 

               Watch your actions; they become habits. 

               Watch your habits; they become character.

               Watch your character; it becomes you

  – Frank Outlaw (1977)


Fowler, S. P., Williams, K., & Hazuda, H. P. (2015). Diet Soda Intake Is Associated with Long‐Term Increases in Waist Circumference in a Biethnic Cohort of Older Adults: The San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society, 63(4), 708-715.

Peper, E., Harvey, R., Takabayashi, N., & Hughes, P. (2009). How to do clinical biofeedback in psychosomatic medicine: An illustrative brief therapy example for self-regulation. Japanese Journal of Biofeedback Research..36 (2), 1-16.

Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic: Random House.

Outlaw, F (1977). What They’re Saying Quote Page 7-B, San Antonio Light (NArch Page 28), Column 4, 1San Antonio, Texas, May 18, 1977 (NewspaperArchive).

*Adapted from: Peper, E. (2016). Legend of two wolves is a beacon across time for healthy thinking. Western Edition. January, pp 6, 8.

Do medications work as promised? Ask questions!

Medications can be beneficial and safe lives; however, some may not work as well as promised. In some cases,  they may do more harm than good as illustrated by the following examples.

  • There is weak or no evidence of effectiveness for the long term use of any opiod (morphine, fentanyl, oxycodone, methadone and hydrocodone) in the treatment of chronic pain (Perlin, 2015). As the Center for Disease Control and Prevention reports, “Since 1999, the amount of prescription painkillers prescribed and sold in the U.S. has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Over prescribing leads to more abuse and more overdose deaths.” More than 16,000 people a year die from prescription drug overdose (CDC, 2016). For a superb discussion of the treatment of chronic pain, see the recently published book by Cindy Perlin, The truth about chronic pain treatments.
  • Selective serotonin re-uptake inhibitor such as Paxil and Prozac (SSRI) are much less effective than promised by pharmaceutical companies. When independent researchers (not funded by pharmaceutical companies) re-analyzed the data from published and unpublished the studies, they found that the medication was no more effective than the placebo for the treatment of mild and moderate depression (Ioannidis, 2008; Le Noury et al, 2015). In addition, the SSRIs (paroxetine and Imipramine) in treatment of unipolar major depression in adolescence may cause significant harm which outweigh any possible benefits (Le Le Noury et al., 2015). On the other had, exercise appears as effective as antidepressants for reducing symptoms of mild to moderate depression (Cooney et al., 2013). Despite the questionable benefits of SSRI medications,  pharmaceutic industry to posted $11.9 billion dollars in 2011 global sales (Perlin, 2015).

When medications are recommended, ask your provider the following questions (Robin, 1984; Gorter & Peper, 2011).

  • Why are you prescribing the medication?
  • What are the risks and negative side effects?
  • Do the benefits outweigh the risks?
  • How do I know when the medication is working?
  • What will you do if the medication does not work?
  • How many patients do you need to treat before one patient benefits?
  • Can you recommend non-pharmaceutical options?

The important questions to ask are:

  • How many patients need to be treated with the medication before one patient benefits?
  • How many will experience negative side effects?

The data can be discouraging. As Daniel Levitin, neuroscientist at McGill University in Montreal and Dean at Minerva Schools in San Francisco, points out, it takes 300 people to take statins for one year before one heart attack, stroke or other serious event is prevented. However, 5% of all the people taken statins (the of drug of choice to lower cholesterol) will experience debilitating adverse effects such as severe muscle pain and gastrointestinal disorders. This means that you are 15 times more likely to suffer serious side effect than being helped by the drug. Nevertheless, the CDC reported that during 2011–2012, more than one-quarter (27.9%) of adults aged 40 and over used a prescription cholesterol-lowering medication (statins) (Gu, 2014).

Before making any medical decision when stressed, watch the superb 2015 TED London presentation by neuroscientist Daniel Levitin, How to think about making a decision under stress.


CDC Center for Disease Control and Prevention (2016). Injury prevention & control: Prescription drug overdose.

Cooney, G.M., Dwan, K., Greig, C.A., Lawlor, D.A, Rimer, J., Waugh, F.R., McMurdo, M., & Mead, G. E.(2013). Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6.The Cochrane Library.

Goter, R. & Peper, E. (2011). Fighting cancer: A nontoxic approach to treatment. Berkeley, CA: Noreth Atlantic Books.

Gu, Q., Paulose-Ram, R., Burt, V.L., & Kit, B.K. (2014).Prescription Cholesterol-Lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012. NCHS Data Brief No. 177. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health Statistics.

Ioannidis, J. P. (2008). Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philosophy, Ethics, and Humanities in Medicine, 3(1), 14.

Le Noury, J., Nardo, J. M., Healy, D., Jureidini, J., Raven, M., Tufanaru, C., & Abi-Jaoude, E. (2015). Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence.

Levitin, D. (2015). How to stay calm when you know you’ be stressed. TEDGlobal London Talk

Perlin, C. (2015). The truth about chronic pain treatments. Delmar, NY: Morning Light Books, LLC.

Robin, E.D. (1984). Matters of life & death: Risks vs. benefits of medical care. New York: W.H. Freeman and Company.